<?php
/**
 * Description of 
 *
 * @author Marco Mounzer
 * @email m.mounzer@gmail.com
 * @copyright 2013
 */
?>
<form action="contattaci.php" method="post" name="form" id="formcontattaci">
    <table width="600px">
        <thead>
            <tr>
                <th colspan="2">
                    Compili la form sottostante, sarà nostra premura contattarla quanto prima.    
                </th>
            </tr>
        </thead>

        <tbody>
            <tr> 
                <th> 
                    Nome
                </th>
                <td>
                    <input name="nome" type="text" id="nome" value="<?php echo (isset($nome) ? $nome : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva il suo nome" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Cognome
                </th>
                <td>
                    <input name="cognome" type="text" id="cognome" value="<?php echo (isset($cognome) ? $cognome : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva il suo cognome" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Via
                </th>
                <td>
                    <input name="via" type="text" id="via" value="<?php echo (isset($via) ? $via : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva la sua via di residenza" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Citt&agrave;
                </th>
                <td>
                    <input name="citta" type="text" id="citta" value="<?php echo (isset($citta) ? $citta : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva la sua citt&agrave; di residenza" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Cap
                </th>
                <td>
                    <input name="cap" type="text" id="cap" size="5" value="<?php echo (isset($cap) ? $cap : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva il codice di avviamento postale della sua citt&agrave;" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Provincia
                </th>
                <td>
                    <select name="provincia" id="provincia">
                        <option value="0" selected>Seleziona</option>
                        <option value="ag">Agrigento</option>
                        <option value="al">Alessandria</option>
                        <option value="an">Ancona</option>
                        <option value="ao">Aosta</option>
                        <option value="ar">Arezzo</option>
                        <option value="ap">Ascoli Piceno</option>
                        <option value="at">Asti</option>
                        <option value="av">Avellino</option>
                        <option value="ba">Bari</option>
                        <option value="bl">Belluno</option>
                        <option value="bn">Benevento</option>
                        <option value="bg">Bergamo</option>
                        <option value="bi">Biella</option>
                        <option value="bo">Bologna</option>
                        <option value="bz">Bolzano</option>
                        <option value="bs">Brescia</option>
                        <option value="br">Brindisi</option>
                        <option value="ca">Cagliari</option>
                        <option value="cl">Caltanisetta</option>
                        <option value="cb">Campobasso</option>
                        <option value="ce">Caserta</option>
                        <option value="ct">Catania</option>
                        <option value="cz">Catanzaro</option>
                        <option value="ch">Chieti</option>
                        <option value="co">Como</option>
                        <option value="cs">Cosenza</option>
                        <option value="cr">Cremona</option>
                        <option value="kr">Crotone</option>
                        <option value="cn">Cuneo</option>
                        <option value="en">Enna</option>
                        <option value="fe">Ferrara</option>
                        <option value="fi">Firenze</option>
                        <option value="fg">Foggia</option>
                        <option value="fo">Forl&igrave;</option>
                        <option value="fr">Frosinone</option>
                        <option value="ge">Genova</option>
                        <option value="go">Gorizia</option>
                        <option value="gr">Grosseto</option>
                        <option value="im">Imperia</option>
                        <option value="is">Isernia</option>
                        <option value="sp">La Spezia</option>
                        <option value="aq">L'Aquila</option>
                        <option value="lt">Latina</option>
                        <option value="le">Lecce</option>
                        <option value="lc">Lecco</option>
                        <option value="li">Livorno</option>
                        <option value="lo">Lodi</option>
                        <option value="lu">Lucca</option>
                        <option value="mc">Macerata</option>
                        <option value="mn">Mantova</option>
                        <option value="ms">Massa Carrara</option>
                        <option value="mt">Matera</option>
                        <option value="me">Messina</option>
                        <option value="mi">Milano</option>
                        <option value="mo">Modena</option>
                        <option value="na">Napoli</option>
                        <option value="no">Novara</option>
                        <option value="nu">Nuoro</option>
                        <option value="or">Oristano</option>
                        <option value="pd">Padova</option>
                        <option value="pa">Palermo</option>
                        <option value="pr">Parma</option>
                        <option value="pv">Pavia</option>
                        <option value="pg">Perugia</option>
                        <option value="ps">Pesaro</option>
                        <option value="pe">Pescara</option>
                        <option value="pc">Piacenza</option>
                        <option value="pi">Pisa</option>
                        <option value="pt">Pistoia</option>
                        <option value="pn">Pordenone</option>
                        <option value="pz">Potenza</option>
                        <option value="po">Prato</option>
                        <option value="rg">Ragusa</option>
                        <option value="ra">Ravenna</option>
                        <option value="rc">Reggio Calabria</option>
                        <option value="re">Reggio Emilia</option>
                        <option value="ri">Rieti</option>
                        <option value="rn">Rimini</option>
                        <option value="rm">Roma</option>
                        <option value="ro">Rovigo</option>
                        <option value="sa">Salerno</option>
                        <option value="ss">Sassari</option>
                        <option value="sv">Savona</option>
                        <option value="si">Siena</option>
                        <option value="sr">Siracusa</option>
                        <option value="so">Sondrio</option>
                        <option value="ta">Taranto</option>
                        <option value="te">Teramo</option>
                        <option value="tr">Terni</option>
                        <option value="to">Torino</option>
                        <option value="tp">Trapani</option>
                        <option value="tn">Trento</option>
                        <option value="tv">Treviso</option>
                        <option value="ts">Trieste</option>
                        <option value="ud">Udine</option>
                        <option value="va">Varese</option>
                        <option value="ve">Venezia</option>
                        <option value="vb">Verbania</option>
                        <option value="vc">Vercelli</option>
                        <option value="vr">Verona</option>
                        <option value="vv">Vibo Valentia</option>
                        <option value="vi">Vicenza</option>
                        <option value="vt">Viterbo</option>
                    </select>
                    <img src="/images/info.png" title="Scelga la provincia del comune di residenza" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Recapito Telefonico
                </th>
                <td>
                    <input name="telefono" type="text" id="telefono" value="<?php echo (isset($telefono) ? $telefono : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva un recapito telefonico, potrebbe esserci utile per ricontattarla" width="16" />
                </td>
            </tr>
            <tr> 
                <th> 
                    Email
                </th>
                <td>
                    <input name="email" type="text" id="email" value="<?php echo (isset($email) ? $email : ''); ?>" /> 
                    <img src="/images/info.png" title="Scriva la sua email per ricevere la nostra risposta" width="16" />
                </td>
            </tr>
            <tr> 
                <th style="vertical-align: top;"> 
                    Messaggio
                </th>
                <td>
                    <textarea name="testo" cols="40" rows="5" wrap="PHYSICAL" id="testo"><?php echo (isset($testo) ? $testo : ''); ?></textarea>
                    <img src="/images/info.png" title="Scriva qui le sue domande" width="16" align="top" />
                </td>
            </tr>
            <tr> 
                <th style="vertical-align: top;"> 
                    Verifica
                </th>
                <td>
                    <img src="/images/securimage_show.php" title="" /><br />
                    <input name="code" type="text" id="code" /> 
                    <img src="/images/info.png" title="Inserisci il codice di verifica" width="16" align="top" />
                </td>
            </tr>
        </tbody>
        <tfoot>
            <tr>
                <th colspan="2">
                    <input type="hidden" id="veicolo" name="veicolo" value="<?php echo (isset($veicolo) ? $veicolo : ''); ?>"/>
                    <input type="hidden" id="email_model" name="email_model" value="<?php echo (isset($email_model) ? $email_model : ''); ?>"/>
                    <input type="submit" id="invia" name="invia" value="Invia"/>
                    <input type="reset" id="reset" name="reset" value="Reset"/>
                </th>
            </tr>
        </tfoot>

    </table>
</form>